Implant and method for posterior sacroiliac fusion

ABSTRACT

An implant and method for posterior sacroiliac fusion having a plate for placement across the posterior surface of the sacroiliac joint, a transverse pin to slide through the plate and transverse the joint as well as provide an aperture to receive bone graft, and a sacral screw to be inserted through the plate.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. Non-Provisionalpatent application Ser. No. 15/847,727 (Attorney Docket No.44057-712.301) filed on Dec. 19, 2017, which is a continuationapplication of U.S. Non-Provisional patent application Ser. No.15/653,284 (Attorney Docket No. 44057-712.201) filed on Jul. 18, 2017,which claims priority to U.S. Provisional Patent Application No.62/363,752 (Attorney Docket No. 44057-712.101) filed on Jul. 18, 2016,as well as U.S. Provisional Patent Application No. 62/448,848 (AttorneyDocket No. 44057-712.102) filed on Jan. 20, 2017, each of which isentirely incorporated herein by reference.

BACKGROUND OF THE INVENTION

The sacroiliac (SI) joint is the juncture between the sacrum at the baseof the spine and the ilium of the pelvis. The SI joint is a synovialjoint in which the sacral surface has hyaline cartilage that movesagainst fibrocartilage of the iliac surface. The SI joint has irregularelevations and depressions that produce interlocking of the two bones.

Disorders of the SI joint can cause low back and radiating buttock andleg pain. Pain associated with the SI joint can be caused by traumaticfracture dislocation of the pelvis, degenerative arthritis,sacroiliitis, or other degenerative conditions. Contributing factorsinclude post-traumatic injury, accelerated wear/instability after lumbarfusion, post pregnancy pain/instability, and longer life span combinedwith a more active lifestyle in many patients.

The SI joint is increasingly being recognized as a pain generator as SIjoint degenerative disease and instability are being diagnosed andtreated more commonly. It is estimated that disorders of the sacroiliacjoint are a source of pain for millions of people suffering from backand radicular symptoms.

Surgical treatment of these disorders includes stabilization and/orarthrodesis. Fusion of the SI joint can be accomplished by severaldifferent conventional methods encompassing an anterior approach, aposterior approach, and a lateral approach. These procedures typicallyinvolve fixation of the sacroiliac joint by placement of one or moretrans-sacroiliac implants or by placement of implants into the SIpedicle and iliac bone.

While these methods have been utilized for fixation and fusion of the SIjoint over the past several decades, in certain circumstances challengeswith respect to the fixation and fusion of the SI joint may remainunresolved. Many of the SI joint fusion procedures on the market todayfixate the SI joint from a challenging lateral approach. Minimallyinvasive procedures such as these are can be technically difficultrequiring extensive surgical training and experience and may result in asubstantial incidence of damage to the lumbosacral neurovascularelements. Furthermore, the lateral approach to the SI joint oftenfixates the joint with multiple implants that go across the joint, notoffering a true fusion approach into the SI joint.

Additionally, current techniques and instruments typically allow foreither fixation or fusion and thereby do not resolve both issues.Procedures are often performed without adequate removal of the articularjoint surfaces or preparation of cortical bone and thereby do not alwaysaddress the degenerative condition of the SI joint.

Failure to sufficiently stabilize and fuse the SI joint with the implantstructures and methods may result in a failure to relieve the conditionof the SI joint being treated, leading to continued or recurrent SIjoint pain and instability requiring additional surgery.

It would therefore be desirable to provide improved methods, systems,and devices that address at least some of these issues.

SUMMARY OF THE INVENTION

The present disclosure generally relates to medical devices and methods,and more particularly relates to implants and methods for fixation andfusion of the sacroiliac joint.

It would be desirable to address the sacroiliac joint through aposterior approach while delivering both fusion and fixation of thejoint. A posterior approach allows for direct visualization of thesacroiliac joint. In examples, the direct visualization of thesacroiliac joint when using a posterior approach is beneficial foreffective decortication to create a proper fusion bed. In someembodiments, once the sacroiliac joint has been decorticated, thesacroiliac joint can be fixated with an implant. In some embodiments,the sacroiliac may be fixated with an implant prior to decortication.Optionally, in any embodiments the sacroiliac joint can be pre-packedwith bone growth inducing material. Optionally, in any embodiments thesacroiliac joint can be post-packed with bone growth inducing material.Optionally, in any embodiments the traverse pin within the implant mayallow for placement of bone growth inducing material extending from theilium, through the sacroiliac joint, and into the sacrum.

An aspect of the invention provides a sacroiliac joint implant systemfor fixating and promoting fusion between an ilium, a sacrum, and asacroiliac joint space. The system comprises a plate/pin componenthaving a plate component and a pin component. The plate component has aniliac portion and a sacral portion, wherein the iliac portion has afirst aperture, wherein the sacral portion has a second aperture, andwherein the iliac portion and said sacral portion have an angle between95-175 degrees disposed therebetween. The pin component is connectedwith said iliac portion of said plate component, said pin configured forplacement through said first aperture, through said ilium, across saidsacroiliac joint space, and into said sacrum. The system furthercomprises a sacral screw inserted into said sacral portion of said platecomponent, said sacral screw configured for placement through saidsecond aperture, through said sacrum.

Another aspect of the invention provides a sacroiliac joint implantsystem for fixating and promoting fusion between an ilium, a sacrum, anda sacroiliac joint space. The system comprises a plate having an iliacportion and a sacral portion, wherein said iliac portion has a firstaperture, wherein said sacral portion has a second aperture, and whereinsaid iliac portion and said sacral portion have an angle between 95-175degrees disposed therebetween. The system also comprises a transversepin inserted into said iliac portion of said plate, said transverse pinconfigured for placement through said first aperture, through saidilium, across said sacroiliac joint space, and into said sacrum, saidtransverse pin comprising a receiving component. Additionally, thesystem comprises a sacral screw inserted into said sacral portion ofsaid plate, said sacral screw configured for placement through saidsecond aperture, through said sacrum, and secured into said receivingcomponent of said transverse pin.

A further aspect of the invention provides a method of fixation andfusion of a sacroiliac joint comprising an ilium, a sacrum, and asacroiliac joint space. The method comprises decortating of saidsacroiliac joint. The method also comprises broaching a first channelthrough said ilium, across said sacroiliac joint space, and into saidsacrum, wherein said first channel is configured to receive a transversepin of a sacroiliac joint implant. Additionally, the method comprisesproviding bone growth inducing material within said sacroiliac jointspace. The method also comprises drilling a second channel into saidsacrum, wherein said second channel is configured to receive a sacrumscrew of said sacroiliac joint implant. The method further comprisesplacing a plate of said sacroiliac joint implant across said sacroiliacjoint space, said place comprising a sacrum portion and an iliumportion. Additionally, the method comprises inserting said transversepin through said plate and through said first channel. The methodfurther comprises inserting said sacrum screw through said plate andthrough said second channel.

An additional aspect of the invention provides a method of fixation andfusion of a sacroiliac joint comprising an ilium, a sacrum, and asacroiliac joint space. The method comprises decorticating the jointspace with a rasp. The method also comprises sliding the plate over saidrasp. Additionally, the method comprises inserting bone screws on thesacral side of the plate. The method also comprises removing the raspthrough the plate. The method further comprises using a box cutter tocreate a track for the transverse pin. Additionally, the methodcomprises inserting the transverse pin. Further, the method comprisesinserting bone screws on the iliac side.

Some embodiments of the apparatus can provide a plate component forplacement over the posterior inferior end of SI joint. In embodiments,the plate component may be integrally connected with a pin componentwhich transversely extends across the SI joint. Embodiments mayadditionally provide one or more bone screws which slides through theplate components. Optionally, in any embodiments at least one bone screwmay be inserted into an opening on the sacral side of the plate, intothe sacrum. Optionally, in any embodiments at least one bone screw maybe inserted into an opening on the iliac side of the plate, into thesacrum. In some embodiments, the one or more bone screws may be straddlethe pin. In some embodiments, one or more bone screws may be threadedinto the pin component.

Some embodiments of the apparatus can provide a plate for placement overthe posterior inferior end of SI joint. Embodiments may also provide apin which slides through an opening on the iliac side of the plate andtransversely extends across the SI joint. Embodiments may additionallyprovide a screw which slides through an opening on the sacral side ofthe plate, into the sacrum. In some embodiments, the screw may threadinto the transverse pin.

The present disclosure also relates to a method including marking thejoint location with fluoroscopy, creating an incision over the iliacwing, dissecting down to the sacroiliac joint, decorticating the jointspace, placing the plate over the posterior inferior end of thesacroiliac joint, drilling a hole through the hole on the iliac side ofthe plate, into the ilium, through the sacroiliac joint, and into asacrum, broaching the hole to fit the shape of the transverse pin,inserting the transverse pin into the plate and through the hole,drilling a hole through the hole in the sacral side of the plate andinto the sacrum, and inserting the sacral screw into the plate andthrough the hole and threading the sacral screw into the transverse pin.

Optionally, in any embodiment the implant can provide a plurality ofbone ingrowth aperture elements for receiving bone growth material andfacilitating fusion of the sacroiliac joint.

Optionally, in any embodiment the methods can include packing theimplant with bone growth inducing material before and/or afterimplantation.

Optionally, in any embodiment the implant can provide an additionaldevice or method to guide the placement of holes in the sacrum andilium. In embodiments, the plate may preferably be placed after thedrilling/broaching of the holes/void. Additionally, the transverse pinmay be inserted. Further, the sacral screw may be inserted and threadedinto the transverse pin.

Additional optional embodiments will be apparent from the detaileddescriptions and the claims herein.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an exemplary embodiment of an implantfor sacroiliac joint fusion.

FIG. 2 is a perspective view of an exemplary embodiment of thetransverse pin.

FIG. 3 is a side cross-section view of an exemplary embodiment of thetransverse pin in FIG. 2.

FIG. 4 is a side view of an exemplary embodiment of the sacral screw.

FIG. 5 is a top view of an exemplary embodiment of the sacral screw ofFIG. 4.

FIG. 6 is a cross-section through an exemplary embodiment of the plate.

FIG. 7 is a perspective view of the embodiment shown in FIG. 1 in thesacroiliac joint space.

FIG. 8 is a cross-section through the embodiment in FIG. 1 in thesacroiliac joint space.

FIG. 9 is a posterior view of a patient with an incision targeting theposterior inferior end of the sacroiliac joint.

FIG. 10 is a lateral view of a patient with posterior dissection to thesacroiliac joint space.

FIG. 11 is a lateral cross-sectional view of decortication of thesacroiliac joint space.

FIG. 12 is a lateral cross-sectional view of a broach creating a voidacross the sacroiliac joint space shaped to receive a transverse pin.

FIG. 13 is a lateral cross-sectional view of a drill creating a voidthrough the sacrum shaped to receive a sacral screw.

FIG. 14 is a cross-sectional view of the implant being packed with bonegrowth inducing material after insertion in the sacroiliac joint space.

FIG. 15 is a perspective view of the implant comprising a plate, pin,and two sacral screws.

FIG. 16A is a perspective view of the implant comprising a plate, pin,two sacral screws, and one iliac screw.

FIG. 16B is a perspective view of the implant comprising a plate, pin,two sacral screws, and two iliac screws.

FIG. 17A is a perspective view of an exemplary embodiment of a bonescrew.

FIG. 17B is a cross-section view of the embodiment in FIG. 17A.

FIG. 17C is a front view of the embodiment in FIG. 17A.

FIG. 17D is a top view of the embodiment in FIG. 17B.

FIG. 18A is a perspective view of an exemplary embodiment of theplate/pin.

FIG. 18B is a cross-sectional front view of the embodiment in FIG. 18A.

FIG. 18C is a cross-sectional side view of the embodiment in FIG. 18A.

FIG. 18D is a top view of the plate/pin shown in FIG. 18A.

FIG. 19 is a perspective view of an exemplary embodiment of a plate/pin.

FIG. 20 illustrates the plate/pin implantation position on across-section of the sacroiliac joint.

FIG. 21 is a perspective view of another exemplary embodiment of atransverse pin.

FIG. 22 is a perspective view of another exemplary embodiment of aplate.

FIG. 23A is a perspective view of an exemplary embodiment of an implantcomprising a plate, curved pin, and four bone screws.

FIG. 23B is a cross-sectional view of the sacrum and ilium to illustrateimplantation position of the plate and curved pin shown in FIG. 21.

FIG. 23C is a cross-sectional front view of engagement between thetransverse pin and plate of FIGS. 21 and 22, respectively.

FIG. 23D is a cross-sectional side view of engagement between thetransverse pin and plate of FIGS. 21 and 22, respectively.

FIG. 24 is a cross-sectional view of the sacrum and ilium to illustrateimplantation position of the plate and curved pin shown in FIG. 21 withthe addition of bone growth inducing material between the sacrum and theilium.

FIG. 25 is a perspective view of an exemplary embodiment of an implantcomprising an integrated plate/pin component having a plate component, acurved pin component, and four bone screws.

FIG. 26 is a cross-sectional view of the sacrum and ilium to illustrateimplantation position of the plate and curved pin shown in FIG. 25.

DETAILED DESCRIPTION OF THE INVENTION

Specific embodiments of the disclosed device and method of use will nowbe described with reference to the drawings. Nothing in this detaileddescription is intended to imply that any particular component, feature,or step is essential to the invention.

FIG. 1 is a perspective view of an exemplary embodiment of an implantfor sacroiliac joint fusion. FIG. 1 illustrates an embodiment withoptional features, any of which may be optionally used or substitutedwith other features in other embodiments discussed herein. Theembodiment of the implant as provided in FIG. 1 illustrates a transversepin 1 and a sacral screw 2 that pass through a plate 3. Optionally, inany embodiments components of the implant may be made of stainlesssteel. Optionally, in any embodiments components of the implant may bemade of titanium. Optionally, in any embodiments some components of theimplant may be made of stainless steel and some components of theimplant may be made of titanium. Optionally, in any embodiments thetransverse pin may be made of porous material. Optionally, in anyembodiments the transverse pin may be made of porous titanium.Optionally, in any embodiments the transverse pin may be made of poroustitanium coated for bone ingrowth.

The implant provided in FIG. 1 may be used to immobilize the sacroiliacjoint. In examples, a plate may be rectangular. In additionalembodiments, a plate may be circular, triangular, elliptical, or anothershape. In some embodiments, a plate may be curved to match the curvatureof the sacrum and ilium across the sacroiliac joint. As anatomy maydiffer between patients, the curvature of a particular plate may differfrom patient to patient. Optionally, in any embodiments curvature may bebetween 95 degrees and 175 degrees Optionally, in any embodimentscurvature may be between 120 degrees and 160 degrees. Optionally, in anyembodiments a plate of the implant, such as plate 3 as seen in FIG. 1,may contain a cylindrical recess extending through the plate with acountersink on one end of the plate for receiving a sacral screw, suchas sacral screw 2, and a recess extending through the plate with acountersink on the opposite end of the plate shaped to receive atransverse pin, such as transverse pin 1. The plate of an implant may beplaced across the sacroiliac joint. In particular, the plate of animplant may be placed across the sacroiliac joint such that a portion ofthe plate is placed against the sacrum, a portion of the plate is placedagainst the ilium, and a portion of the plate is placed across thesacroiliac joint gap. Additionally, the transverse pin may be placedthrough its corresponding hole in the plate. Optionally, in anyembodiments the transverse pin may be placed with a sliding fit throughits corresponding hole in the plate. Optionally, in any embodiments thetranverse pin may be threaded through its corresponding hole in theplate. Further, the sacral screw may be placed through its correspondinghole in the plate. Optionally, in any embodiments the sacral screw maybe placed with a sliding fit through its corresponding hole in theplate. Optionally, in any embodiments the sacral screw may be threadedthrough its corresponding hole in the plate. In examples, the sacralscrew may be placed with a fit through it corresponding hold in theplate, through the sacrum, through the aperture in the transverse pin,and then threaded into the shaft of the transverse pin.

Optionally, in any embodiments the sacral screw comprises a cylindricalbody and cylindrical head Optionally, in any embodiments, the body maybe a different shape, such as a generally square-ish shape or agenerally triangular shape, or another example of a different shape.Optionally, in any embodiments the head may be a different shape, suchas a generally square-ish shape or a generally triangular shape, oranother example of a different shape. Optionally, in any embodiments thehead may have a larger diameter than the body. Optionally, in anyembodiments the sacral screw may comprise a socket to receive a driverthat can rotate the screw. Optionally, in any embodiments the socket isa hex socket. In some embodiments, the socket may be a different shape.In examples, the cylindrical body may consist of a non-threaded portionand threaded distal tip. Optionally, in any embodiments transverse pin 1may comprise a predominantly triangular body of three intersectingcircular regions with one flat side and head 4. Optionally, in anyembodiments the transverse pin may comprise a different shape, such as acylindrical shape or a rectangular box-like shape, among other examples.Optionally, in any embodiments head 4 may be of similar but larger shapethan the corresponding body of the traverse pin. The aperture throughthe main body of transverse pin 1 may consist of a flat upper part andangled lower surface such that it has a smaller opening on one side anda larger opening on the opposite side. Optionally, in any embodimentsthe angled lower surface by be between 30 degrees and 60 degrees.Optionally, in any embodiments the angled lower surface may beapproximately 45 degrees. Optionally, in any embodiments the angledlower surface may be based on an angle of entry that a sacral screwenters when inserted through a plate that has a sacral component that isangled based on geometry of a patient's anatomy. Because of this, theangled lower surface may have an angle that is customized based upon apatient's anatomy. In examples, the angled lower surface may have areceiving component to receive a distal portion of a sacral screw. Insome embodiments, transverse pin may comprise a threaded blind hole toreceive the distal threaded tip of sacral screw 2. In examples, animplant as described herein can be effectively placed using a posteriorsurgical approach. In embodiments, the implants may be sized accordingto the local anatomy. In particular, the implants may be sizedaccordingly to the local anatomy of particular patients.

FIG. 2 is a perspective view of an exemplary embodiment of thetransverse pin, such as transverse pin 1, that may be used in an implantdescribed herein. FIG. 2 illustrates an embodiment with optionalfeatures, any of which may be optionally used or substituted with otherfeatures in other embodiments discussed herein. FIG. 2 shows a preferredembodiment of transverse pin 1. Transverse pin 1 may comprise apredominantly triangular body of three intersecting circular regionswith one flat side and head 4 of similar but larger shape as thecorresponding body of traverse pin 1. The head of the traverse pin mayengage with a plate of an implant. In examples, a head 4 of traverse pin1 may engage with plate 3, as shown in FIG. 1. As seen in FIG. 2, acylindrical hole 5 extends from head 4 to aperture 15. Cylindrical hole5 may extend from head 4 to aperture 15 so as to allow for packing ofthe aperture with bone growth inducing material after the transverse pinis implanted and aperture 15 through transverse pin 1 with a flat upperpart and angled lower surface such that it has a smaller opening on oneside and a larger opening on the opposite side.

Aperture 15 may allow for the insertion of bone growth inducingmaterial. Examples of bone inducing material may include biologics,agents, medical adhesives, bonding cements, and/or bone healingsubstances. Optionally, in any embodiments the transverse pin mayinclude some features to help contain bone growth inducing material.Optionally, in any embodiments aperture 15 may include retaining wallsto help pre-packed bone growth inducing material during transverse pininsertion. Additionally, transverse pin 1 may comprise a threaded, blindhole 6 shaped to receive the threaded portion of a sacral screw. Inparticular, traverse pin 1 may comprise a threaded, blind hole 6 shapedto receive the threaded portion of sacral screw 2, as shown in FIG. 1.Hole 6 may extend normal to the angled surface of aperture 15, which maycontain an internal thread 7 for connection to sacral screw 2, as shownin FIG. 1.

FIG. 3 is a side cross-section view of an exemplary embodiment of thetransverse pin in FIG. 2. FIG. 3 illustrates an embodiment with optionalfeatures, any of which may be optionally used or substituted with otherfeatures in other embodiments discussed herein. In particular, FIG. 3shows a cross-sectional view of the transverse pin 1 in FIG. 2.Transverse pin comprises a predominantly triangular body of threeintersecting circular regions with one flat side and head 4 of similarbut larger shape than the triangular body of traverse pin 1.Additionally, FIG. 3 also illustrates longitudinal pin axis 17 andtraversing thread axis 18. Thread axis 18 may be offset from pin axis 17such that when transverse pin 1 and sacral screw 2 are attached to theplate, as shown in FIG. 1, the screw axis 8 of sacral screw 2 is coaxialwith thread axis 18. Optionally, in any embodiments thread axis 18 maybe in-line with a threaded, blind hole shaped to receive the threadedportion of sacral screw 2, as shown in FIG. 1. Optionally, in anyembodiments transverse pin 1 may also contain an aperture with a flatupper part and angled lower surface such that traverse pin 1 has asmaller opening on one side and a larger opening on the opposite side.Transverse pin 1 may also contain a chamfered, cylindrical holeextending from head 4 to aperture 15.

FIG. 4 is a side view of an exemplary embodiment of a sacral screwwithin an implant. FIG. 4 illustrates an embodiment with optionalfeatures, any of which may be optionally used or substituted with otherfeatures in other embodiments discussed herein. In particular, FIG. 4 isa preferred embodiment of the sacral screw 2. The sacral screw maycomprise a screw axis 8 longitudinal, a cylindrical body 14, and a panhead 9 for engaging a driver tool that can rotate the screw. Optionally,in any embodiments a driver tool may be engaged by another type of head.The sacral screw may further comprise an external machine screw thread10 along a distal portion of the length of the tubular body 14 to engagewith transverse pin 1, as shown in FIG. 1.

FIG. 5 illustrates a top view of an exemplary embodiment of the sacralscrew of FIG. 4. FIG. 5 illustrates an embodiment with optionalfeatures, any of which may be optionally used or substituted with otherfeatures in other embodiments discussed herein. In particular, FIG. 5illustrates a top view of a preferred embodiment of sacral screw 2 head9 with hexagonal recess 11 for receiving a driving tool. The diameter ofcylindrical head 9 may be larger than the diameter of cylindrical body14 as shown in FIG. 4. In examples, the diameter of cylindrical head 9may be larger than the diameter of cylindrical body 14 so as to providea stop to prevent driving the screw in too deep into the bone of thepatient.

FIG. 6 is a cross-section through an exemplary embodiment of the plate.FIG. 6 illustrates an embodiment with optional features, any of whichmay be optionally used or substituted with other features in otherembodiments discussed herein. FIG. 6 illustrates a sacral portion and aniliac portion. Additionally, FIG. 6 is a preferred embodiment of plate3. On one end, plate 3 comprises a cylindrical recess 12 extendingthrough the plate with a countersink 15 for receiving sacral screw 2 andhead 9, respectively. Optionally, in any embodiments cylindrical recess12 may comprise a slotted region that may snap into place once a screwis screwed in so as to prevent a head of a sacral screw from backing outof the cylindrical recess. Optionally, in any embodiments the sacralportion may have a different shaped recess, such as a triangular recessor a square-shaped recess, among other shapes. Optionally, in anyembodiments the shape of the sacral screw may match the shape of therecess within the sacral portion. Optionally, in any embodimentsrecesses 12 and/or 13 within a sacral portion or iliac portion,respectively, may be threaded.

In examples, plate 3 may contain on the opposite end and in anotherplane transverse that of the screw hole a recess 13 extending throughthe plate with a countersink 16 to receive transverse pin 1 and head 4,respectively. Head 9 of sacral screw 2 and head 4 of transverse pin 1may be flush with the surface of the plate at recesses 12 and 13respectively. Optionally, in any embodiments head 4 of transverse pin 1may not be flush with recess 13. Optionally, in any embodiments head 9of sacral screw 2 may not be flush with the surface of the plate atrecess 12. Countersinks 15 and 16 may prevent driving sacral screw 2 andtransverse pin 1, respectively, in too deep into the bone of thepatient. The bone contacting the inner surface of the plate may beconcave and the outer surface may be convex. More specifically, theplate may be angled 95 to 175 degrees such that surface 55 is flush withthe sacrum and surface 56 is flush with the ilium allowing thread 10 ofsacral screw 2 to thread into thread 7 of transverse pin 1.

FIG. 7 illustrates a perspective view of the embodiment shown in FIG. 1in the sacroiliac joint space. FIG. 7 illustrates an embodiment withoptional features, any of which may be optionally used or substitutedwith other features in other embodiments discussed herein. Inparticular, FIG. 7 shows the transverse pin 1, the sacral screw 2, andthe plate 3 fixating the sacrum 53 and ilium 54. In examples, theimplant illustrated in FIG. 7 may be that of any implant describedherein. In particular, the implant illustrated in FIG. 7 as beingattached to the ilium and sacrum may be that of any implant describedherein.

FIG. 8 illustrates a cross-section through the embodiment in FIG. 1 inthe sacroiliac joint space. FIG. 8 illustrates an embodiment withoptional features, any of which may be optionally used or substitutedwith other features in other embodiments discussed herein. FIG. 8 showsa cross section of the transverse pin 1, the sacral screw 2, and theplate 3 in the sacroiliac joint space. FIG. 8 may be viewed to highlightthe surface area available for bone growth inducing material 31. Bonegrowth inducing material 31 may be used to enhance fusion. Plate 3 mayspan across sacrum 53 and ilium 54. Transverse pin 1 extends throughplate 3, through ilium 54, and into sacrum 53. Sacral screw 2 may extendthrough plate 4, into the sacrum, and may be threaded into transversepin 1.

FIGS. 9-11 illustrates embodiments for delivering an implant, such as inFIGS. 1-8 above, into a sacroiliac joint space of a patient. FIG. 9illustrates a posterior view of a patient with an incision targeting theposterior inferior end of the sacroiliac joint. FIG. 9 illustrates anembodiment with optional features, any of which may be optionally usedor substituted with other features in other embodiments discussedherein. FIG. 9 shows the location of an incision 40 at the posteriorinferior end of the sacroiliac joint. The sacroiliac joint isillustrated as having a sacro component 53 and an iliac component 54.

FIG. 10 is a lateral view of a patient with posterior dissection to thesacroiliac joint space. FIG. 10 illustrates an embodiment with optionalfeatures, any of which may be optionally used or substituted with otherfeatures in other embodiments discussed herein. FIG. 10 illustratesdissection 41 down to the posterior inferior end of the sacroiliac jointspace using a standard cobb-like instrument with a sweeping motion inthe same plane as the joint. Optionally, in any embodiments analternative instrument for dissection 41 may be conducted using

FIG. 11 is a lateral cross-sectional view of decortication of thesacroiliac joint space. FIG. 11 illustrates an embodiment with optionalfeatures, any of which may be optionally used or substituted with otherfeatures in other embodiments discussed herein. FIG. 11 illustratesdecortication 42 of the sacroiliac joint space using a rectangularrasp-like instrument to remove outer cortical bone from both sacrum andilium with a reciprocating in/out motion.

FIG. 12 illustrates the use of a broach 43 to create a void 44 throughthe ilium 54 and into the sacrum 53 that is shaped to receive transversepin 1. FIG. 12 illustrates an embodiment with optional features, any ofwhich may be optionally used or substituted with other features in otherembodiments discussed herein. A mallet may be used to hammer on the backend of the broach to advance the broach for void creation. Optionally,in any embodiments the broach may include depth markings to indicatewhen the broach is at the proper depth and thereby when the void lengthmatches the length of the intended transverse pin. Optionally, in anyembodiments the void matches the shape and length of the pin. In theseexamples, the amount of material that is removed is also based on theshape and length of the pin. Optionally, in any embodiments a void iscreated that is greater than the shape and length of the pin.Optionally, in any embodiments excess void area is filled in bone growthinducing material. Optionally, in any embodiments void 44 is generatedafter decortication. As seen in FIG. 12, the space between the sacrumand ilium is larger in the decorticated section that was shown in FIG.11.

FIG. 13 illustrates the use of a drill 45 to create a void 46 throughthe sacrum 53 that is shaped and located to receive sacral screw 2. FIG.13 illustrates an embodiment with optional features, any of which may beoptionally used or substituted with other features in other embodimentsdiscussed herein. The diameter of drill 45 is preferably sized to matchthe minor diameter of the threaded shaft of screw and may include depthmarkings to indicate what length screw to choose.

FIG. 14 illustrates a bone growth inducing material delivery device 52comprising a conical funnel and long tube for introducing bone growthinducing material 31. FIG. 14 illustrates an embodiment with optionalfeatures, any of which may be optionally used or substituted with otherfeatures in other embodiments discussed herein. Additional examples mayinclude a syringe injection for the bone growth inducing material, handdelivery of the bone growth inducing material, or other examples ofproviding the bone growth inducing material to the joint space. Examplesof bone growth inducing material may include autograft, allograft,medical adhesives, bonding cements, and/or bone healing substances.Optionally, in any embodiments bone growth inducing material may beprovided into the joint space through the transverse pin 1 after implantinsertion in the sacroiliac joint space. Bone growth inducing materialmay be inserted into the funnel. Optionally, in any embodiments aplunging tool such as a cylindrical rod may be used to push the bonegrowth inducing material through the long tube and into the hole in thepin that extends from the pin head to the slotted region. In this way,the slotted region that crosses the sacroiliac joint may be filled withbone growth inducing material.

FIG. 15 shows a preferred embodiment of the implant where a one-piece orintegral/monolithic plate/pin 70 and two bone screws 60 in the sacrummay immobilize the sacroiliac joint. FIG. 15 illustrates an embodimentwith optional features, any of which may be optionally used orsubstituted with other features in other embodiments discussed herein.The two bone screws 60 as provided in FIG. 15 are positioned so as tostraddle the pin component of plate/pin 70. Optionally, in anyembodiments the bone screws 60 may not touch the pin component ofplate/pin 70. Optionally, in any embodiments the bone screws 60 may benon-parallel. The plate component and pin component of plate/pin 70 mayform an L-shaped or J-shaped bracket having an elongated linear sectionextending along an axis, and a shorter section coupled to one end of theelongated linear section and extending transverse to the axis.Optionally, in any embodiments the elongated linear section and theshorter section may be integrally formed. Optionally, in any embodimentsthe elongated linear section and the shorter section may be coupleabletogether. The angle between the shorter section and the elongated linearsection may preferably ranges from 15 to 75 degrees. The short section,which may also be known as a plate component, may include one or moreholes sized to receive a bone screw for securing the implant to thesacrum. The elongated linear section, which may also be known as a pincomponent, may form a pin that traverses through the ilium and sacrum.Optionally, in any embodiments the pin component that is formed may besized such that it does not contact the bone screw(s). Additionally, thepin component may have a rectangular slotted region extending throughthe elongated linear section in which bone graft material may bedisposed for facilitating fusion

FIGS. 16A and 16B are similar to FIG. 15 except that FIGS. 16A and 16Balso comprise one or more bone screws to be inserted into the ilium.Similar to FIG. 15, FIGS. 16A and 16B include a rectangular aperturewithin a pin portion of plate/pin 80 that may be used to deliver bonegrowth inducing material. Additionally, similar to FIG. 15, FIGS. 16Aand 16B include an irregular aperture within a plate portion ofplate/pin 80 that may be used to deliver bone growth inducing material.In particular, FIG. 16A and 16B show a preferred embodiment of theimplant where a one-piece integral or monolithic plate/pin 80, bonescrews 60 in the sacrum, and one or more bone screws in the iliumimmobilize the sacroiliac joint. FIG. 16A illustrates a monolithicplate/pin 80 having two bone screws to be inserted into the sacrum andone bone screw to be inserted into the ilium. FIG. 16A illustrates anembodiment with optional features, any of which may be optionally usedor substituted with other features in other embodiments discussedherein. FIG. 16B illustrates a monolithic plate/pin 80 having two bonescrews to be inserted in to the sacrum and two bone screws to beinserted into the ilium. FIG. 16B illustrates an embodiment withoptional features, any of which may be optionally used or substitutedwith other features in other embodiments discussed herein. In examples,an implant may have more than two bone screws to be inserted into thesacrum. In examples, an implant may have more than two bone screwsinserted into the sacrum. The holes for receiving the screws may beangled relative to one another so that the screws are also angledrelative to one another and so that the screws enter the bone at adesired angle. In embodiments, the angles may be any angle that matchesthe patient's anatomy. In preferred embodiments the relative anglebetween any two adjacent iliac or sacral screws may preferably diverge5-30 degrees, more preferably 10-20 degrees, and more preferably divergeabout 15 degrees. In examples, two or more bone screws may benon-parallel with respect to one another.

In examples, the plate component and pin component of plate/pin 80 mayform an L-shaped or J-shaped bracket having an elongated rectangular orlinear section extending along an axis, and a shorter section coupled toone end of the elongated linear section and extending transverse to theaxis. The short section may include one or more holes sized to receive abone screw for securing the implant to the sacrum. The elongated linearsection may form a pin that traverses through the iliac and sacrum, anda distal portion of the elongated linear portion may be beveled orotherwise shaped to have a sharp point to help penetrate bone. It mayhave a rectangular slotted region extending through the elongated linearsection in which bone graft material may be disposed for facilitatingfusion. As seen in FIG. 16A, the two sacral screws may be placed throughtwo holes on the short section of the plate and into the sacrum andpreferably disposed on either side of and not in contact with theelongated linear section. Also as seen in FIG. 16A, one iliac screw maybe placed through a hole. The hole may be centrally located through thejunction between the short section of the plate and the elongated linearsection. The iliac screw may be placed through the hole into the ilium.As seen in FIG. 16B, two sacral screws may be placed through two holeson the short section of the plate and into the sacrum. The two sacralscrews may be preferably disposed on either side of, and not in contactwith, the elongated linear section. As also seen in FIG. 16B, two iliacscrews may be placed through two holes, the holes located through thejunction between the short section of the plate and the elongated linearsection, and into the ilium. Optionally, in any embodiments the shortersacral portion may be flat and planar. Optionally, in any embodimentsthe shorter sacral portion may have an arcuate surface that matches thecontours of the sacrum. Optionally, in any embodiments the screw headsmay preferably fit into the holes such that the screw heads are flush.Optionally, in any embodiments the screw heads may fit below the outersurface of the plate.

FIGS. 17A-17D show a preferred embodiment of the bone screw 60 that maybe used with any of the implants described herein. FIG. 17A illustratesa perspective view of an exemplary embodiment of a bone screw. FIG. 17Aillustrates an embodiment with optional features, any of which may beoptionally used or substituted with other features in other embodimentsdiscussed herein. FIG. 17B illustrates a cross-section view of theembodiment in FIG. 17A. FIG. 17B illustrates an embodiment with optionalfeatures, any of which may be optionally used or substituted with otherfeatures in other embodiments discussed herein. FIG. 17C illustrates afront view of the embodiment in FIG. 17A. FIG. 17C illustrates anembodiment with optional features, any of which may be optionally usedor substituted with other features in other embodiments discussedherein. FIG. 17D illustrates a top view of the embodiment in FIG. 17B.FIG. 17D illustrates an embodiment with optional features, any of whichmay be optionally used or substituted with other features in otherembodiments discussed herein.

The bone screw may contain an externally threaded, cylindrical head 62that extends along the same axis as an elongated, externally threaded,cylindrical shaft 63 of smaller diameter. Threaded head 62 may engagewith internally threaded holes 78 or 81 of plate/pin 70 or plate/pin 80as shown in FIGS. 15 and 16, respectively. In examples, the threadedhead may engage with internally threaded holes of any plate/pinembodiment disclosed herein. Threaded shaft 63 may be disposed throughthe plate/pin along the axis of the threaded holes. In examples,threaded shaft 63 may be preferably disposed along the majority/entirelength of the screw shaft, may engage with bone, and may thereby securethe implant to the sacrum or ilium. Threaded shaft 63 may also containcutting flute 64 adjacent the distal end and a tapered tip 66 at thedistal portion thereof, to aid in insertion, both of which extend alongthe screw's axis. Threaded head 62 has larger diameter than screw shaftand may also contain countersunk hex socket 61 and internal threadedhole 65 to engage with an insertion tool, again extending along itsaxis. Bone screw 60 may vary in length 10 to 100 mm and may vary indiameter 4 to 12 mm, although these dimensions are not limiting and maybe adjusted based on the patient's anatomy being treated.

FIGS. 18A-18D show a preferred embodiment of plate/pin 70 which containsan oval, elongated linear section or “pin member” 72 extending along anaxis and a shorter rectangular section or “plate member” 71 coupled toone end of the elongated linear section and extending transverse to thelongitudinal axis of the elongated linear section. FIG. 18A is aperspective view of an exemplary embodiment of the plate/pin. FIG. 18Aillustrates an embodiment with optional features, any of which may beoptionally used or substituted with other features in other embodimentsdiscussed herein. FIG. 18B is a cross-sectional front view of theembodiment in FIG. 18A. FIG. 18B illustrates an embodiment with optionalfeatures, any of which may be optionally used or substituted with otherfeatures in other embodiments discussed herein. FIG. 18C is across-sectional side view of the embodiment in FIG. 18A. FIG. 18Cillustrates an embodiment with optional features, any of which may beoptionally used or substituted with other features in other embodimentsdiscussed herein. FIG. 18D is a top view of the plate/pin shown in FIG.18A. FIG. 18D illustrates an embodiment with optional features, any ofwhich may be optionally used or substituted with other features in otherembodiments discussed herein.

The pin member and the plate member may optionally take the same form asdescribed in other embodiments, such as in FIG. 15 or 16. Plate member71 may contain a sacrum contacting surface 73 and ilium contactingsurface 74, the angle (indicated by a dotted curve in FIG. 18B) betweenwhich may vary preferably 95 to 175 degrees, although other angles arepossible depending on the patient's anatomy. Plate member 71 may alsocontain a slotted region 76 which may be cruciform shaped. In additionalexamples, the slotted region may be another desired shape such as round,rectangular, triangular, oval, as well as other examples. The slottedregion may allow the surgeon to see the joint and pack additional bonegraft material through it if desired. Plate member 71 may also contain ahex socket or similar feature 79 and threaded hole 78 which extend alongor substantially parallel to the axis of the pin member and engage withan impaction tool that helps drive the pin into bone. Plate 71 alsocontains diverging, preferably 5 to 30 degrees, internally chamfered andthreaded sacral screws holes 77 with unthreaded, cylindrical section 82adjacent to the bone contacting surface of the plate member to preventbone screws 60 from translating through the plate. Pin member 72traverses the sacroiliac joint, first passing through the ilium, thencrossing the joint, and finally entering the sacrum, as shown in theimplantation position in FIG. 20. Pin member 72 varies in lengthpreferably 20 to 60 mm and may contain a rectangular slotted region 75extending through the pin member in which bone graft material may bedisposed for facilitating fusion. Other aspects of the implant maygenerally take the same form as other embodiments described herein.

FIG. 19 shows a preferred embodiment of plate/pin 80 which contains anelongated linear section or “pin member” 72 extending along an axis, anda shorter section or “plate member” 71 coupled to one end of theelongated linear section and extending transverse to the axis. FIG. 19illustrates an embodiment with optional features, any of which may beoptionally used or substituted with other features in other embodimentsdiscussed herein. Plate/pin 80 also contains internally threaded bonescrew hole(s) 77 and 81 to receive bone screw(s) 60 to engage with thesacrum and ilium, respectively. Bone screw hole(s) 81 also features anunthreaded cylindrical section 82 adjacent to the bone contactingsurface of the plate/pin to prevent bone screw(s) 60 from translatingthrough the device.

FIG. 20 illustrates the plate/pin 70 or 80 implantation position on across-section of the sacrum 53 and ilium 54. FIG. 20 illustrates anembodiment with optional features, any of which may be optionally usedor substituted with other features in other embodiments discussedherein. Here the elongate linear portion, or pin 72, passes through thesacrum and ilium and the shorter portion, or plate 71, has an arcuatesurface that allows the shorter portion to conform to the sacrum andilium where it may be screwed into position as described in otherfigures. The implant comprising plate/pin 70 or 80 also includes bonescrew(s) (not shown) that pass into the sacrum and bone screw(s) (notshown) that pass into the ilium. Examples of bone screws inserted into aplate/pin, such as plate/pin 70 or 80, are provided throughout thedisclosure. Embodiments of bone screws as described herein may be usedin accordance with plate/pin 70 or 80, as well as other implantconfigurations.

FIG. 21 is a perspective view of another exemplary embodiment of atransverse pin 83 having a curved oval main body 85. FIG. 21 illustratesan embodiment with optional features, any of which may be optionallyused or substituted with other features in other embodiments discussedherein. Curved main body 85 has a tapered end 86 to allow for placementof transverse pin 83 between and not in contact with two bone screws inthe sacrum and extension 95 traverse to the main body. Extension 95contains two partially threaded diverging bone screw holes 77 withunthreaded section 82 to receive and act as a stop for bone screws to beplaced through transverse pin 83 and into the ilium. Optionally, in anyembodiments different inserter features may be provided for insertingbone screws. Extension 95 also contains threaded blind hole 90. Inexamples, blind hole 98 may be used to engage with an inserter tool.Additionally, extension 95 also comprises overhang 89. Overhang 89 mayhook around a corresponding pocket in plate 84 in FIG. 22 so as to stopfrom driving transverse pin 83 in too deep. In examples, overhang 89 mayact as a hard stop during insertion. In examples, overhang 89 may helpprevent rotation of the pin relative to the plate. Transverse pin 83 mayalso contain two rectangular rails 88 extending along the narrow ends 86of oval main body 85. Ends 86 of oval main body 85 may be tapered.Rectangular rails 88 may follow the curve partially along extension 95.Rails, such as rectangular rails 88, may act as a guide for transversepin 83 implantation. In examples, rails may act as a guide for insertingtransverse pin 83 during implantation. Rails may contain flat end 94that, upon engagement with plate 84 in FIG. 22, may prevent transversepin 83 from backing out. Transverse pin 83 also contains aperture 87.Aperture 87 extends through transverse pin 83 and, as illustrated inFIG. 21, has a generally rectangular portion that tapers towards an end.In examples, aperture 87 may approximate the shape of main body 85 andtaper 86. Optionally, in any embodiments aperture 87 may be packed withbone growth inducing material. Optionally, in any embodiments aperture87 may be packed with bone growth inducing material prior toimplantation. Optionally, in any embodiments bone growth inducingmaterial that is provided to a sacroiliac joint gap, or an adjacentarea, may be provided through aperture 87. Examples of bone growthinducing material may include biologics, agents, medical adhesives,bonding cements and/or bone healing substances. In examples, a curvedtransverse pin, such as pin 83 illustrated in FIG. 21, may be shaped forplacement through the ilium, through the sacroiliac joint space, andinto the sacrum.

Optionally, in any embodiments a transverse pin, such as transverse pin83, may be between 20 mm-60 mm in length. Optionally, in any embodimentsa transverse pin may be less than 20 mm, 20 mm, 25 mm, 30 mm, 35 mm, 40mm, 45 mm, 50 mm, 55 mm, 60mm, or more than 60 mm. In examples, pinlengths may vary. In examples, pins described throughout this disclosuremay vary in length. Optionally, in any embodiments a pin may vary inlength based on anatomy of a patient. In examples, bone screws may havea divergence between 0 degrees-30 degrees. Optionally, in anyembodiments bone screws may have a divergence of 0 degrees, 5 degrees,10 degrees, 15 degrees, 20 degrees, 25 degrees, 30 degrees, or more than30 degrees.

FIG. 22 is a perspective view of another exemplary embodiment of a plate84 which is rectangular in shape with sacrum contacting surface 73 andilium contacting surface 74, the angle between which may vary preferably95 to 175 degrees, although other angles are possible depending on thepatient's anatomy. FIG. 22 illustrates an embodiment with optionalfeatures, any of which may be optionally used or substituted with otherfeatures in other embodiments discussed herein. Plate 84 also contains aslotted region 76 which may be cruciform shaped or any other desiredshape such as round, rectangular, triangular, oval, etc., and allows thesurgeon to see the joint, aiding in proper plate placement, and packadditional bone graft material through it if desired. Plate 84 alsocontains diverging, preferably 5 to 30 degrees, internally chamfered andthreaded sacral screws holes 77 with unthreaded, cylindrical section 82adjacent to the bone contacting surface of the plate member to preventbone screws 60 from translating through the plate. Plate 84 alsocontains two slots 92 traverse to the iliac contact surface of the plateand pocket 93 partially extending along the lateral outer edge of plate84. Slots 92 and pocket 93 may be shaped to receive rails 88 andoverhang 89, respectively, of transverse pin 83 in FIG. 21. Plate 84also contains two arms 96 on either side of the iliac side of the plate,with the long edge parallel to ilium contact surface 74 that may flareoutward during transverse pin 83 insertion and return to neutralposition (e.g., that shown in FIG. 22) once transverse pin 83 is fullyseated.

FIG. 23A is a perspective view of another exemplary embodiment of animplant comprising a transverse pin, such as transverse pin 83 of FIG.21; a plate, such as plate 84 of FIG. 22; and four bone screws, such asbone screws 60 of FIG. 17. FIG. 23A illustrates an embodiment withoptional features, any of which may be optionally used or substitutedwith other features in other embodiments discussed herein. As seen inFIG. 23, bone screws 60 include two sacral screws and two iliac screws.FIG. 23B is a cross-sectional view of the sacrum 53 and ilium 54 toillustrate implantation position of plate 84 and curved pin 83 shown inFIG. 21. FIG. 23B illustrates an embodiment with optional features, anyof which may be optionally used or substituted with other features inother embodiments discussed herein. As seen in FIG. 23B, plate 84 isplaced with sacrum contacting surface 73 adjacent to the sacrum 53 andilium 54 contacting surface 74 adjacent to ilium 54 and curved pin 83shown in FIG. 21. Transverse pin 83 is placed through plate 84,extending through ilium 54, and partially extending into the sacrum 53.FIG. 23C is a cross-sectional front view of engagement between theoverhang 89 of transverse pin 83 and pocket 93 of plate 84 of FIGS. 21and 22, respectively. FIG. 23C illustrates an embodiment with optionalfeatures, any of which may be optionally used or substituted with otherfeatures in other embodiments discussed herein. FIG. 23D is across-sectional side view of engagement between rail end 94 oftransverse pin 83 and snap 91 of arm 96 of plate 84 of FIGS. 21 and 22,respectively. FIG. 23D illustrates an embodiment with optional features,any of which may be optionally used or substituted with other featuresin other embodiments discussed herein. As seen in FIG. 23D, snap 91 is asquare extension at the lateral end of each arm 96 extending towards thecenter of plate 84 such that when transverse pin 83 is seated in plate84, snap 91 blocks rail end 94 to prevent transverse pin 83 from backingout.

FIG. 24 is a cross-sectional view of sacrum 53 and ilium 54. FIG. 24illustrates an example of an implantation position of plate 84 andcurved pin 83 shown in FIG. 21 with the addition of bone growth inducingmaterial 97. FIG. 24 illustrates an embodiment with optional features,any of which may be optionally used or substituted with other featuresin other embodiments discussed herein. As seen in FIG. 24, bone growthinducing material 97 has been sized to fit through joint visualizationwindow 76 seen in FIG. 22, between sacrum 53 and ilium 54, and throughaperture 87 seen in FIG. 21. Optionally, in any embodiments the bonegrowth inducing material may be integrated within the plate. Optionally,in any embodiments the bone growth inducing material may be integratedwithin the plate such that the bone growth inducing material may slideinto the sacroiliac joint as the plate is being placed. Optionally, inany embodiments the bone growth inducing material may be connected tothe plate. Optionally, in any embodiments the bone growth inducingmaterial may be connected to the plate such that the bone growthinducing material may slide into the sacroiliac joint as the plate isbeing placed. Embodiments having bone growth inducing material that isconnected to and/or integrated within the plate may be optionally usedor substituted with other features in other embodiments discussedherein.

FIG. 25 is a perspective view of an exemplary embodiment of an implantcomprising an integrated plate/pin component having a plate component98, a curved pin component 99, and four bone screws 60. FIG. 25illustrates an embodiment with optional features, any of which may beoptionally used or substituted with other features in other embodimentsdiscussed herein. In particular, the implant comprises two sacral screwsand two iliac screws. As seen in FIG. 25, plate component 98 and pincomponent 99 of the illustrated integrated pin/plate component areformed of a single body.

FIG. 26 is a cross-sectional view of the sacrum 53 and ilium 54 toillustrate implantation position of the plate component 98 and curvedpin component 99 shown in FIG. 25. As seen in FIG. 26, plate component98 is placed with sacrum-contacting surface 73 adjacent to the sacrum 53and ilium-contacting surface 74 adjacent to ilium 54. Pin component 99extends through plate component 98, further extending through ilium 54,extending across a sacroiliac joint space between said sacrum 53 andilium 54, and partially extending into the sacrum 53.

While preferred embodiments of the present disclosure have been shownand described herein, it will be obvious to those skilled in the artthat such embodiments are provided by way of example only. Numerousvariations, changes, and substitutions will now occur to those skilledin the art without departing from the invention. It should be understoodthat various alternatives to the embodiments described herein may beemployed in practicing the invention. It is intended that the followingclaims define the scope of the invention and that methods and structureswithin the scope of these claims and their equivalents be coveredthereby.

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 15. (canceled)16. A method of fixation and fusion of a sacroiliac joint comprising anilium, a sacrum, and a sacroiliac joint space, the method comprising:decorticating of said sacroiliac joint; broaching a first channelthrough said ilium, across said sacroiliac joint space, and into saidsacrum, wherein said first channel is configured to receive a transversepin of a sacroiliac joint implant; pre-packing an aperture within saidtransverse pin with bone growth inducing material: drilling a secondchannel into said sacrum, wherein said second channel is configured toreceive a sacrum screw of said sacroiliac joint implant; placing a plateof said sacroiliac joint implant across said sacroiliac joint space,said plate comprising a sacrum portion and an ilium portion; insertingsaid transverse pin through said plate and through said first channel;and inserting said sacrum screw through said plate and through saidsecond channel.
 17. The method of claim 16, further comprising providingbone growth inducing material within said sacroiliac joint space priorto placement of said sacroiliac joint implant.
 18. The method of claim16, further comprising providing bone growth inducing material withinsaid sacroiliac joint space after placement of said sacroiliac jointimplant.
 19. The method of claim 16, further comprising providing bonegrowth inducing material within said sacroiliac joint space prior toplacement of said sacroiliac joint implant and wherein a portion ofproviding bone growth inducing material within said sacroiliac jointspace after placement of said sacroiliac joint implant.
 20. The methodof claim 16, further comprising providing bone growth inducing materialto said sacroiliac joint space through a second aperture within saidplate.
 21. The method of claim 16, inserting said sacrum screw within areceiving component of said transverse pin.
 22. The method of claim 16,wherein placing said plate comprises placing said sacrum portion flushwith said posterior surface of a sacrum of a patient.
 23. The method ofclaim 16, wherein placing said plate comprises placing said iliumportion flush with said posterior surface of an ilium of a patient. 24.The method of claim 16, wherein an angle between a bone contactingsurface of said sacrum portion and a bone contacting surface of saidilium portion is between 95 degrees and 175 degrees.
 25. The method ofclaim 16, wherein an angle between a bone contacting surface of saidsacrum portion and a bone contacting surface of said ilium portion isadjustable.
 26. The method of claim 16, wherein an angle between saidsacrum portion and said ilium portion is configured to match anatomy ofa particular patient.
 27. The method of claim 16, further comprising:drilling a third channel into said ilium, wherein said third channel isconfigured to receive an ilium screw of said sacroiliac joint implant;and inserting said ilium screw through said plate and through said thirdchannel.
 28. The method of claim 16, wherein said aperture furthercomprises walls configured to retain said bone growth inducing material.29. The method of claim 16, wherein said aperture is configured todeliver bone growth inducing material to said sacroiliac joint space.30. The method of claim 16, wherein said aperture is configured todeliver bone growth inducing material to said sacrum.
 31. The method ofclaim 16, wherein said aperture is configured to deliver bone growthinducing material to said ilium.